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Is Obesity A Disease? Debate Recap & Podcast

Last Thursday the Canadian Obesity Network Student and New Professionals hosted Drs Jacqui Gingras and Arya Sharma in Ottawa for a debate discussion titled “Is Obesity a Disease?”. We had a great turnout (~110 people) and some excellent discussion amongst our debaters and our audience members.

I have embedded the audio of the debate below (email subscribers can listen by visiting the blog itself). It’s a long file (just shy of 2 hours) so I would strongly suggest downloading the file (click here) to listen to it on the go, or simply subscribe to the Obesity Panacea podcast in itunes (click here).

[Update: Reader Johan took the liberty of normalizing the sound levels so that the comments during the Q&A are a bit louder – thanks Johan! You can download that version of the file here]

[Update: The video of the debate is now online as well, and can be viewed below. For a higher resolution version of the video which is more suitable for lectures, public presentations, etc, feel free to contact me through the comments section below. Also, feel free to distribute/embed/edit the video, as it has a Creative Commons Attribution licence. Thanks to Joseph Abdulnour for doing a fantastic job with the video!]

The debate was broken into 3 subsections, and moderated by Dr Mark Tremblay:

Section 1: The health impact of obesity – does obesity cause increased health risk, or is it merely an innocent bystander?

Section 2: The medicalization of obesity – how has obesity come to be viewed as a medical condition, and is this a good or bad thing?

Section 3: Concluding statements: Should obesity be viewed as a disease?

Each section also included an opportunity for a brief rebuttal from each of our experts, as well as 10 minutes of Q&A with the audience (which included a fair number of obesity experts as well).

Areas of agreement

One of the first things that the two debaters agreed upon is that BMI is useless as a means of defining obesity. Instead, Dr Sharma argued that obesity should be defined as “as a condition in which excess body fat threatens or affects health”, and that it is in this sense that obesity should be considered a disease. Similarly, there was no disagreement whatsoever about the very real harm done by weight bias and discrimination.

Areas of disagreement

As expected, the primary area of disagreement came over whether the medicalization of obesity would be helpful or harmful to people with excess body weight. Dr Gingras argued that obesity has already been medicalized/pathologized, and that it is this very medicalization that promotes weight bias. As people are constantly exposed to the message that “fat kills”, they have begun to look down upon people with above average weight as being unhealthy or worse (scroll through the comment thread on any obesity-related mainstream media article to see how individuals with obesity are viewed by the general public).

In contrast Dr Sharma argued that it is precisely because obesity is not viewed as a disease by the medical establishment, it has instead been positioned as a “lifestyle” problem. From a post on his website the morning after the debate (the entire post is well worth reading):

It is exactly because we do not exclusively leave the diagnosis of obesity (which I define as a condition in which excess body fat threatens or affects health) to trained, licensed, and regulated health professionals, that we have created a ‘free-for-all’ where we continue propagating the myth that everyone with a few extra pounds is unhealthy and needs to lose weight. This is the key downside of not medicalising obesity – if only a trained health professional can tell whether or not your weight is affecting your health then someone without this training, should not be making assumptions about your health simply based on your size – indeed, it will hopefully become common knowledge that only your doctor or nurse can tell whether you have obesity or not.

Dr Sharma also argued that by failing to medicalize obesity, we continue to allow charlatans and snake-oil salesmen to promote their ridiculous (and often harmful) “cures” for obesity, which would not be possible if obesity were viewed as a legitimate disease by the government and medical establishment (as an example, he pointed out that you can’t open up an unregulated “cancer treatment center” in a strip mall, but you certainly can open a weight loss center wherever you please).

My thoughts, and one more area of agreement

Both Drs Sharma and Gingras made excellent points, and to be honest it’s tough to decide exactly where I come down on this issue. It almost seems as though obesity has been medicalized in every way except the one that matters. It has certainly been medicalized in the eyes of the general public, and on this issue I agree with Dr Gingras that it has had very real negative consequences for people viewed as being too heavy. However, the fact that the government/medical establishment continue to view obesity (defined using Dr Sharma’s definition, rather than BMI) as a lifestyle problem rather than a genuine disease, has also led to lack of qualified medical support on this issue, as well as evidence-based public health strategies.

In the end Dr Gingras pointed out one other key area where she and Dr Sharma were in agreement, and that was the issue of improved training for healthcare professionals. Regardless of whether or not you think that obesity is a disease, there is little doubt that healthcare professionals receive inadequate training in how to deal with obesity-related issues, and that this has negative consequences for their patients.

In addition to the above audio of the debate we also have a video recording which I will be putting online as soon as possible (my goal is early next week). The podcast is released with a creative commons license, so feel free to repost/embed/edit/reuse as you see fit.

Thanks everyone!

A big thanks to the many people and organizations who helped organize the debate.

Our presenters (Drs Sharma, Gingras, and Tremblay)

Our funders (CIHR through a Cafe Scientifique grant, as well as the Canadian Obesity Network Student and New Professionals organization, and in-kind support from the Healthy Active Living and Obesity Research Group at the Children’s Hospital of Eastern Ontario Research Institute),

The organizing committee at the University of Ottawa CONSNP (Joseph, Zach, Angela, Megan and Richard)

The press officers at the Canadian Obesity Network (Brad Hussey), the CHEO RI (Adrienne Vieanneau) and University of Ottawa (Thalie Tremblay)

Our hosts at the Richelieu Vanier Community Center

Last but not least, all of the individuals who attended the event and contributed to the discussion.

Additional thoughts?

There was plenty of passionate debate about this issue on Thursday – let me know what you think!

Travis

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Travis Saunders has a PhD in Human Kinetics, and is currently an Assistant Professor in Applied Human Science. His research focuses on the relationship between sedentary time (e.g. sitting) and chronic disease risk in both children and adults. He is also a Certified Exercise Physiologist and (former) competitive distance runner. You can connect with him on Twitter @TravisSaunders.

12 comments

Not sure if this came up in the course of the debate but I think obesity can be medicalized without being considered a “disease” in the strict sense of that term. Elevated LDL cholesterol comes to mind as a comparison. It isn’t a disease in itself, but it contributes as a risk factor to diseases and so is medicalized with health professionals being educated in dealing with it. I’m not clear on how obesity could ever be considered a disease in and of itself.

I agree with Dr. Sharma that a distinction should be made between obesity that threatens health and just excess weight measured as BMI. In reality though people often want to lose excess weight even if it doesn’t threaten their health. It may just be for vanity or it may be preventative to not getting to the point where it could threaten their health or otherwise impact their life. In these cases, there is nothing wrong with “non-medicalized” interventions involving diet and exercise. Most doctors know very little of nutrition anyway so framing things as “legitimate medical intervention” vs. “quackery and snakeoil salesmen” only is a pretyy heavy bias. I’m sure there are at least some legitimate weight management programs out there.

Seems like medicalisation of the condition would possibly allow a more holistic approach to treating obesity instead of blaming just one thing (e.g. food, the individual etc). Interesting too, that BMI is now being discredited – it makes sense to have more scientific and meaningful measure of more criteria and define chronic conditions systematically.

I should preface this with the saying I’m no audio engineer or such, but I do happen to have access to a copy of Adobe Audition CS6, which has a Speech Volume Leveler filter. I ran it on the episode and it did help. You no longer need to keep change the volume all the time when listening to it. The sound quality of some of the questions is still pretty low. I hope I don’t violate any copyright or such in sharing the file.

Everything on this blog (and the whole network) is done using a creative commons attribution license, so you can do anything you want with the content, so long as you give credit to the original. Feel free to make a dubstep remix if you like 🙂 But really, that’s awesome that you did that, thanks so much!

I obviously need to get better sound edit capabilities so I can autotune it over the dubstep mix and dance to it 🙂

One thing I’d like to see addressed more is that the so-called ‘lifestyle’ factors associated with obesity (overeating, lack of exercise, excessive junk food, etc) are also bad for thin folks. Doesn’t have to make you fat to harm your health.

Let me start off by mentioning that I have been “classified” as being morbidly obese.

I wrote the following on my blog a while ago….

Is obesity a disease?

I think this depends on who answers the question.

Someone who is obese may use this as an excuse for being obese, rather than accept that the lifestyle that they are following is at fault.

I think it is more a case that obesity may lead to certain conditions such as diabetes and heart disease.

Obesity, in itself, is not a disease.

The debate around this question may stem from the fact that it costs billions of dollars each year to treat obesity related conditions such as those mentioned.

In my mind, a disease displays symptoms; what symptoms does obesity display?

Excess fat, but is that not by definition, what obesity is? You don’t wake up one morning and find that you have gained fifty pounds. With a disease, you could quite easily wake up one morning and find that you are running a fever.

Obesity rates increase not because we are becoming more prone to diseases, they increase because our lifestyles have changed dramatically with the onset of things like television and video games.

We have become less active and live on fast foods, which impact negatively on our lives; a product of this being obesity.

What if obesity is classified as a disease?

The obese will look for uneccessary medical resolutions to their condition, but the underlying issues like lifestyle, fast food and other factors would not be addressed.

“I’m not clear on how obesity could ever be considered a disease in and of itself. ”
What do you mean, it practically meets the criteria for Koch’s postulates*, what with the mouse-microbiome fecal transfer studies. What is more diseaselike than “give mouse B the microbes from mouse A, watch mouse B become like mouse A”?

*NB: not really, since Koch along with most all of microbiology is obsessed with the single isolated clone thing.

Obesity, more than anything else, strikes me as the blind man and the elephant. It looks different from the point of view of an exercise physiologist than it does from the perspective of a nutritional scientist. And it looks different still from the perspective of a microbiologist or immunologist.

I think what we really want are cheap and easy surrogates for cancer and heart disease risk (those are, after all, the big killers). BMI is actually a pretty bad option, it’s just cheaper and easier than most anything else. ‘Body fat percentage’ + ‘blood lipid/cholesterol profiles’ + ‘aerobic fitness performance on standardized tasks’ + ‘background/chronic inflammation profile’ (yet to be fully worked out) plugged into some empirically derived formula is probably what we’ll eventually go with.